Tuesday, June 14, 2011
On Death Panels
Perhaps a consequence of advanced medicine and medical technology is prolonging life and treating heretofore untreatable conditions. In other words, we can do more than we used to. Many of these emerging treatment phenomena are still young and therefore costly, creating a situation where we are able to treat sick people and save lives but often at staggering financial cost. So we are forced to make decisions about health economy in a way we maybe never have been before, and we are seeing the ability to save life run right up against financial prudence. Two conditions exist simultaneously - human life is sacred, saving it is costly. Therefore, what are our moral obligations to people with illnesses that can otherwise be treated but which treatment costs a great deal? From a perspective of individual sanctity and human worth, surely a wealthy person does not morally deserve better healthcare than a poor person - yet it is a reality that ongoing high-level care simply cannot be provided on an equal basis (Not every person with pancreatic cancer can have Steve Jobs's level of care). With a completely private health system the price mechanism rations care, yet makes no account for moral desert and human dignity (that someone who cannot afford a heart transplant, cancer drug, etc, does not make them undeserving of it); and with a completely public health system there is still a problem of finite resources where the federal government simply could not collect enough revenue to pay for all possible treatments (to say nothing of damage to the overall economy in trying to pursue this). There is of course an uneven ability for consumers to pay for healthcare, combined with a cutting edge healthcare system that offers lifesaving treatment often at exorbitant prices. People are dying because they can't pay - that is immoral. It is financially impossible to give everyone the same robust level of care. Can it be true that at some point it is unfeasible to prolong life; is say a six month prolongation of life worth hundreds of thousands of dollars (to an individual who can personally finance it? To one who can't?); how about an eighteen month prolongation? Two years? Five? In other words how do we square the simultaneous truths that all life is worth saving and doing so is often prohibitively expensive?
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Here is a good headline from a UK death panel: http://www.bloomberg.com/news/2011-07-14/novartis-fails-to-win-u-k-backing-for-lucentis-in-diabetic-eye-condition.html
ReplyDeleteSo the question is how to ration healthcare? I am not so sure how to address the question ethically (which is why it has taken me so long to respond). But now I believe that may be a moot point. Economic realities may force us to consider feasibility and sustainability over ethical considerations (yes it would be great if everyone could get every therapy but no one, neither the patient nor insurance companies nor drug companies nor nations can afford that sustainably).
I think the economic reality is that we will move to a system more closer to the UK where large government run health care plans like Medicare and Medicaid and maybe even some large private plans, will have to ration based on cost of therapy against anticipated benefits.
I strongly believe in keeping a parallel private healthcare system for a few reasons. First, this gives patients a right to a choice about their therapy, but forces them to have some skin (or tumor) in the game. It would be ghastly for the government to decide that I could not get a cancer treatment, but if it were going to cost my life savings maybe I would reconsider. Yes this does mean that the rich will get access to more treatments than the poor. Second, costly experimental therapies are not worthless, they are essential parts of the medicine research machine. If you were thinking about designing a drug against such and such disease and had some great preliminary data, but realized it would not get government approval and hence no profit, then you would cease that line of research. That would be detrimental to other potential therapies and discoveries in the future.
So to sum up what I think, I believe we need to shift the economics so that more of the costs of healthcare are borne by the individual. I prefer the individual having the choice of therapy, but clearly the economic set up is not sustainable with the benefit going to the individual, the cost going to society and the decision being made the individual. I believe whoever bears the cost should make the decision, so if that is a death panel for state run healthcare plans, so be it, or if it is the individual with expensive supplemental private insurance, so be it.
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